Healing wounds of body, mind

Karen Mellen, Tribune staff reporterCHICAGO TRIBUNE

For most of her 22 years as a nurse, only one sort of patient could really rattle Sharron Chivari's nerves: a sexual assault victim.

Trained to deal with all sorts of medical trauma--but not sexual assault--the nurse at Central DuPage Hospital in Winfield relied on trial and error to find the best ways to collect evidence for police, treat the patients' injuries and, hopefully, help ease emotional pain.

"In the emergency department, that was the one thing that really heightened our anxiety," she said. "You sure don't want to make any mistakes at that time."

But Chivari's concern has been replaced with confidence. She is one of about 35 nurses statewide who have received specialized training to treat victims of sexual assault and collect forensic evidence. It is part of a nationwide trend to expand services for victims.

Called sexual assault nurse examiners, or SANEs, the nurses learn how to find and collect evidence that might suggest sexual contact was not consensual. The nurses also are trained in how to testify at a trial, and they keep up to date on local resources to refer the victim to counseling and other services.

In addition, unlike a doctor in a busy emergency room who must deal with several patients at once, nurses often are able to treat only the sexual assault patient.

"How individuals are treated and what their response is immediately after an assault will impact how they adjust later," said Kathy Bell, president of International Association of Forensic Nurses in Pitman, N.J. "I hope someday every rape victim and suspect would have the opportunity to have the exam done by someone who is trained."

Sexual assault nurse examiners have been around since the 1970s. But the number of programs has only grown during the last decade.

In Illinois, SANE programs got a boost in 1999, when the state administered grants for pilot programs in DuPage, Lake, Cook and Champaign Counties. Besides Central DuPage, Chicago-area hospitals that have a SANE program include Edward Hospital in Naperville, Good Samaritan in Downers Grove, Midwestern Regional in Zion, Victory Memorial in Waukegan and Lake Forest Hospital.

Two hospitals in Urbana and one in Peoria also have SANEs, and officials in Kankakee County are hoping to start a program.

"Although I'd like to see SANE programs spread a lot faster, it's going pretty well," said Lynn Nash, director of advocacy services for the Lake County Council Against Sexual Assault. "Two and a half years ago, we were told by prosecutors it was never going to happen. It did."

The model for SANEs varies, but can include an on-call system in which a SANE is called to the hospital every time a sexual assault is reported. In other hospitals, a specially trained nurse will be relieved of his or her other duties when a sexual-assault victim comes in.

Advocates say sexual assaults are underreported nationwide, and some think the way the exam usually is performed is partly to blame. In the past, sexual assault victims often waited hours before seeing a doctor, and the exam sometimes was conductedin view of other patients.

Even under the best circumstances, collecting evidence and checking for injuries after a sexual assault can be grueling, with intrusive questions and probing instruments. Add to that a doctor or nurse who is nervous, busy or hostile, and it's no wonder victims shied away from reporting the incident, experts say.

"There's a lot of self-blame, or shame," among victims, said Linda Ledray, director of the Sexual Assault Resource Service in Minneapolis and a forensic nursing expert. "They need to know the people they are going to meet are going to understand them and support them through that."

Nurses say the training, which was developed by the International Association of Forensic Nurses, gives them the confidence to explain the medical and legal steps necessary to pursue a sexual-assault complaint.

"We're trained in all the different disciplines, so you know what law enforcement is doing and what is trauma doing," said Nancy Salamie, a sexual-assault nurse examiner at Edward. "There is a comprehensive approach to the victim."

Law enforcement officials who have dealt with sexual-assault nurse examiners say the nurses help the criminal justice system because they better understand what sort of injuries are consistent with a sexual assault. They also are trained to testify in court, requiring less preparation time than other witnesses.

Dan Guerin, supervisor of domestic violence and child abuse unit of DuPage County state's attorney's office, said he prefers working with sexual assault nurse examiners because they have chosen to receive extra training, which shows they already have an interest in the cases.

Nevertheless, the specialists represent only a fraction of emergency-room nurses in Illinois. That's because a nursing shortage makes it difficult for hospitals to train nurses in a new specialty and allow them to treat only one patient in a busy emergency room, officials say.

In addition, not all nurses want to learn.

Even so, Illinois officials are heartened by the response to the programs.They hope to develop standards for treating child victims of sexual assault.

"We've come a long way," said Sharon Dimitrijevich, manager of special-care units at Midwestern Regional in Zion. "We have the support of the medical communities, judicial, law enforcement, advocacy. We're much farther ahead than three years ago, when we first started this."